Other weaknesses include our assumption of 100% adherence to treatment and so on. However, the most significant strength of this study is that our economic model depends totally on evidence from Japan only, which could justify our simplification in modelling on data availability basis. There is an opportunity for further refinement of our economic model, because a large-scale field trial evaluating the effect of multifactorial treatment including lifestyle modification for early-stage CKD [46] is ongoing in Japan, which will enable us to model progression of CKD with more rigorous clinical evidence [47]. In conclusion, we, the Japanese Society of Nephrology Task Force for the Validation of Urine Selleckchem Regorafenib Examination as

a Universal Screening, recommend to mandate use of serum Cr assay in addition to the current dipstick test in the next revision of SHC, from the viewpoint of value for money and the importance of secondary prevention (Table 4). check details We think that continuation of current policy, in which dipstick test only is mandatory, is still a sensible policy option. Development of adequate Specific Counselling Guidance for screened participants is also recommended. Table 4 Recommendation of the Japanese Society

of Nephrology Task Force for the validation of urine examination as a universal screening Mandate use of serum Cr assay in addition to the current dipstick test in the next revision of SHC Whereas the primary objective of this study is to appraise policy options in Japanese context,

it also demonstrates that good value for money can be expected from mass screening with dipstick test to check proteinuria in population with high prevalence; that is, a population L-NAME HCl strategy could be adopted for control of CKD. However, caution is needed when extrapolating this conclusion, since the scope of costing of our economic model does not cover the initial cost of launching mass screening. The model here is based on currently running SHC. The practice of annual mass screening for adults in Japan is quite exceptional, while such universal programmes are rarely found in other countries [48]. Acknowledgments We gratefully acknowledge contributions of the staff members who collected the data for this study at Ruxolitinib regional screening centres, Dr. T. Sairenchi for preparing the basic screening data, Ms M. Yokoyama for her assistance in medical cost calculation and Dr. S. Fujimoto, Dr. T. Konta, Dr. H. Sugiyama, Dr. N. Ura, Dr. Y. Yasuda, Dr. T. Tokura, Dr. E. Noiri, Dr. I. Narita and Dr. S. Uchida for their valuable discussions. This work was supported by Health and Labour Sciences Research Grants for “Research on the positioning of chronic kidney disease (CKD) in Specific Health Check and Guidance in Japan” (20230601), and a grant for strategic outcome study project for renal disease (H19-renal disease-senryaku-001), the Ministry of Health, Labour and Welfare of Japan.